Deck 3: Administration of Aerosolized Agents

Question 1

Your patient is receiving gentamicin (a high-viscosity antibiotic solution)via gas-powered small volume nebulizer.To compensate for the increased viscosity of the aerosol solution,you should

A)set the gas flow to 6 L/min.
B)set the gas flow to 12 L/min.
C)recommend a different method of drug delivery.
D)both A and C.

Answer 1

set the gas flow to 12 L/min.

Question 2

An aerosol is best defined as

A)a drug in liquid form.
B)vapor suspended in a carrier gas.
C)a suspension of solid or liquid particles in a carrier gas.
D)an invisible drug particle.

Answer 2

a suspension of solid or liquid particles in a carrier gas.

Question 3

After delivering an aerosol treatment,you notice that approximately 0.5 mL of medication remains in the small volume nebulizer.Which of the following actions do you take?

A)Replace the nebulizer before administering the next treatment
B)Recommend that subsequent doses be delivered via metered dose inhaler (MDI)
C)Take no action and deliver the following dose with the same small volume nebulizer
D)Double the amount of medication administered during the next treatment

Answer 3

Take no action and deliver the following dose with the same small volume nebulizer

Question 4

What is the particle size range for pulmonary diagnostic and therapeutic applications?

A)0.5 to 1 µm
B)1 to 10 µm
C)10 to 15 µm
D)15 to 25 µm

Question 5

The physician has ordered your patient to receive continuous administration of heliox with racemic epinephrine secondary to postextubation stridor.As you approach the bedside to deliver the ordered dose of racemic epinephrine via small volume nebulizer,what outcome should you expect with a gas flow of 10 L/min of heliox?

A)The nebulization time will be less than when using oxygen as a power gas.
B)The mass median aerodynamic diameter (MMAD)of the aerosolized medication will be greater than when using oxygen as a power gas.
C)There will be a twofold increase in nebulization time (compared with oxygen as a power gas).
D)The MMAD and nebulization time will remain unchanged.

Question 6

Traditionally,what percentage of a given dose of aerosolized medication reaches the lower respiratory tract,regardless of the type of delivery device being used?

A)5% to 10%
B)10% to 15%
C)20% to 30%
D)40% to 50%

Question 7

A 7-month-old infant presents with a diagnosis of respiratory syncytial virus.The attending physician agrees with your recommendation of ribavirin to treat the disease.Because ribavirin is delivered as an aerosol,you must decide which method of delivery to use.Which of the following aerosol administration devices would you choose?

A)Small volume nebulizer
B)Large volume nebulizer
C)Dry powder inhaler (DPI)
D)Small particle aerosol generator (SPAG)

Question 8

Two hypothetical small volume nebulizers,A and B,have the following specifications from the manufacturer:
Which nebulizer would be best to use to treat the lower respiratory tract?

A)Nebulizer A
B)Nebulizer B

Question 9

Which of the following are problems associated with patient use of an MDI?
1)Failure to coordinate inhalation and actuation of the inhaler
2)A too-rapid inspiratory flow rate
3)Failure to shake and mix canister contents
4)Cessation of inspiration as the aerosol strikes the throat

A)1 and 2 only
B)2 and 3 only
C)1,2,and 3 only
D)1,2,3,and 4

Question 10

Your patient carries an albuterol MDI,which she claims to use every few weeks.She complains that the first dose actuated from the device seems to have no effect on her bronchospasm.What suggestion would you make to correct the problem?

A)Discharge a waste dose before using the MDI
B)Replace the device
C)Administer three actuations instead of the two that her physician prescribed
D)Recommend use of a small volume nebulizer

Question 11

Advantages of using portable ultrasonic drug nebulizers include that they

A)require an electrical source.
B)are inexpensive.
C)are very durable.
D)are small in size.

Question 12

All metered dose inhalers (MDIs)are powered by which propellant?

A)Chlorofluorocarbons (CFCs)
B)Soy lecithin
C)Hydrofluoroalkanes (HFAs)
D)Oleic acid

Question 13

You are a respiratory therapist working in the emergency department;a 67-year-old man with chronic bronchitis presents in acute distress.His vital signs include heart rate (HR)123 beats/min and respiratory rate (RR)28 breaths/min.On auscultation,you note faint expiratory wheezing.Which of the following devices would be the least appropriate by which to deliver an aerosolized drug to this patient?

A)Jet nebulizer
B)Metered dose inhaler (MDI)
C)MDI with spacer
D)Dry powder inhaler (DPI)

Question 14

Which of the following statements is true concerning the recommended volume of solution when delivering an aerosol treatment via a small volume nebulizer?
1)A volume between 3 mL and 5 mL of solution is recommended.
2)Increasing the volume results in a decrease in the concentration of drug remaining in the dead volume when nebulization ceases.
3)Patient compliance of therapy is directly proportional to its convenience.
4)Increasing the volume of solution results in a net increase in the amount of active drug in the nebulizer.

A)1 and 2 only
B)2 and 3 only
C)1,2,and 3 only
D)1,2,3,and 4

Question 15

The main uses of aerosol therapy in respiratory care include the following:
1)Humidification of dry gases
2)Improved mobilization and clearance of secretions
3)Delivery of aerosol drugs to the respiratory tract
4)Delivery of nutrients for patients unable to chew food

A)1 and 2 only
B)1,2,and 3 only
C)1,2,and 4 only
D)1,2,3,and 4

Question 16

You are instructing the parents of a 4-year-old child with asthma on how to deliver aerosolized medication at home via a traditional small volume jet nebulizer.When the parents ask how much of the medication actually reaches the child's lungs,you answer :

A)5% to 10% of the total drug dose.
B)10% to 15% of the total drug dose.
C)50% to 60% of the total drug dose.
D)Nearly 100% of the total drug dose.

Question 17

A 2-year-old child is seen in the emergency department of a local hospital,and croup is diagnosed.The physician orders a dose of racemic epinephrine via a small volume nebulizer to help reduce the subglottic swelling.What size aerosol particle is most likely to deposit in this region,providing the greatest therapeutic benefit to the patient?

A)Particles less than 10 µm
B)Particles 5 to 10 µm
C)Particles 2 to 5 µm
D)Particles 0.8 to 3.0 µm

Question 18

What is the purpose of the end-inspiratory breath hold used in conjunction with aerosol delivery?

A)Prevents the patient from hyperventilating
B)Gives the aerosol more time to reach BTPS conditions
C)Allows better deposition through gravitational settling
D)Reduces inertial impaction

Question 19

You are treating a patient who has a confirmed diagnosis of Pneumocystis pneumonia.Which type of delivery device should you choose to administer the dose of pentamidine ordered by the attending physician?

A)Respirgard II
B)MDI
C)Pari LC
D)DPI

Question 20

You are administering an aerosol treatment to a patient via a small volume nebulizer when you realize that the output appears to be much less than normal.On checking the flow meter,you see that it is set to 4 L/min.Your next action is to:

A)Decrease the flow to 2 L/min
B)Increase the flow to 20 L/min
C)Leave the flow rate unchanged and search for other sources of decreased output
D)Increase the flow rate to 8 L/min

Question 21

This device is propellant-free and utilizes mechanical energy in the form of a tension spring to deliver medication.

A)Breath-enhanced nebulizer
B)Breath-actuated jet nebulizer
C)Ultrasonic nebulizer
D)Soft-mist inhaler

Question 22

The greatest limitation to patient use of a dry powder inhaler (DPI)is

A)patient preference.
B)patient coordination.
C)patient ability to provide an inspiratory flow rate of 30 to 90 L/min.
D)cost.

Question 23

The most common error in use of pressurized metered dose inhalers (pMDIs)is

A)actuation of the pMDI at total lung capacity.
B)inadequate shaking and mixing of pMDI contents before use.
C)failure to coordinate actuation of pMDI with inhalation.
D)exhaling during pMDI actuation.

Question 24

A medical student asks about the different ways albuterol and ipratropium bromide can be delivered.What would you tell the student?
1)pMDI
2)DPI
3)Respimat soft-mist inhaler
4)Solution for nebulization

A)1 and 4 only
B)2,3,and 4 only
C)1,3,and 4 only
D)1,2,3,and 4

Question 25

The physical mechanisms usually considered for aerosol particle deposition in the human lung include which of the following?
1)Inertial impaction
2)Gravitational settling
3)Diffusion

A)1 only
B)2 and 3 only
C)1,2,and 3 only
D)1 and 3 only

Question 26

This device is electrically powered and operates on the piezoelectric principle and is capable of high output.

A)Breath-enhanced nebulizer
B)Breath-actuated jet nebulizer
C)Ultrasonic nebulizer
D)Soft-mist inhaler

Question 27

You are teaching proper use of a metered dose inhaler (MDI)to an elderly man who is having trouble coordinating actuation of the device with an inspiratory effort.What suggestion(s)would you make to help him with his problem?

A)Suggest adding a reservoir device
B)Suggest that if he cannot effectively use the MDI,he may need to switch to an SVN
C)Both A and B
D)Neither A nor B

Question 28

The physician has granted your request to change a patient from a small volume nebulizer (SVN)to a metered dose inhaler (MDI)for administration of albuterol.The dose via SVN was 2.5 mg of drug.What is the equivalent dose via MDI to administer to your patient?

A)1 puff
B)2 puffs
C)3 puffs
D)4 puffs

Question 29

Your patient asks how long to wait between the first and second doses from her albuterol MDI.You suggest that she

A)pause 15 minutes between actuations.
B)not pause at all,but deliver both actuations as quickly as possible,preferably over a time period of 1 second.
C)pause 1 to 5 minutes between actuations.
D)pause 30 minutes between actuations.

Question 30

Asthma was recently diagnosed in your patient,and she was prescribed albuterol PRN.She asks you to suggest a delivery device for her albuterol.She is a college student with a busy schedule and spends little time at home.What suggestion would you make?

A)pMDI
B)Ultrasonic nebulizer
C)Small volume nebulizer
D)Breath-actuated nebulizer

Question 31

Barring any issues regarding patient coordination or ability to use the device correctly,how should you suggest that a patient administer a drug with an MDI if no spacer is available?

A)Insert the MDI into the mouth and make a tight seal with the lips.
B)Hold the MDI several centimeters in front of the open mouth.
C)Never use the device without a spacer.
D)Insert the MDI into the mouth and make a loose seal with the lips.

Question 32

A measure of the dispersion of a distribution,calculated as the ratio of particle size below which 84% of the particles occur to the particle size below which 50% occur,in a log-normal distribution is termed

A)count mode.
B)count median diameter (CMD).
C)mass median diameter (MMD).
D)geometric standard deviation (GSD).

Question 33

Advantages of small volume nebulizers (SVNs)include which of the following?
1)Ability to aerosolize many drug solutions
2)Minimal cooperation or coordination required for inhalation
3)Drug concentration and dose can be modified
4)Normal breathing pattern can be used

A)1 only
B)2 and 3 only
C)1 and 3 only
D)1,2,3,and 4 only

Question 34

This device allows greater aerosol release during inspiration,while decreasing output during exhalation or breath hold (example: Pari LC).

A)Breath-enhanced nebulizer
B)Breath-actuated jet nebulizer
C)Ultrasonic nebulizer
D)Soft-mist inhaler

Question 35

This device releases aerosol only during inspiration,allowing all released aerosol to be available for patient inhalation (examples: AeroEclipse,Circulaire).

A)Breath-enhanced nebulizer
B)Breath-actuated jet nebulizer
C)Ultrasonic nebulizer
D)Soft-mist inhaler

Question 36

You have been asked to administer albuterol to a neonate who is currently not intubated.Which of the following aerosol devices would be age appropriate?

A)Dry powder inhaler (DPI)
B)Metered dose inhaler (MDI)with reservoir/mask
C)Small volume nebulizer (SVN)
D)Both B and C

Question 37

Your patient is receiving a Duoneb via a small volume nebulizer (SVN)powered by compressed oxygen as part of her maintenance therapy drug regimen.The cylinder runs out before the treatment can be completed.What action would you suggest?

A)Switch remaining treatment to a metered dose inhaler (MDI)
B)Switch remaining treatment to a dry powder inhaler (DPI)
C)Used compressed air to complete the treatment
D)Chart that the treatment was not completed and move to your next patient

Question 38

The physical method used to measure aerosol particle size distribution that uses multiple steps in determining sizes of aerosol particles is referred to as

A)the laser scattering method.
B)the Mie-scattering theory.
C)a cascade impactor.
D)none of the above.

Question 39

The physician has requested that you provide a patient with a reservoir device to use in conjunction with a metered dose inhaler (MDI).Given a choice,which type of device would you give the patient?

A)Spacer
B)Traditional holding chamber
C)Antistatic valved holding chamber
D)Non-antistatic valved holding chamber

Question 40

Your patient informs you that she keeps her albuterol MDI stored in her refrigerator because she feels that this keeps the medication "fresher" for a longer time.What is your best response?

A)Tell her that is a fine idea and that you may make the same recommendation to other patients.
B)Suggest that she put it in the freezer instead because the colder temperature may keep the drug "fresher" for a longer time.
C)Request that she no longer refrigerate the canister but instead store it at room temperature.
D)Tell her to place the MDI in the bottom drawer of the refrigerator because this will keep it the "freshest."

Question 41

A device that disperses individual doses that are premetered into a blister,which is mechanically punctured when the cover is lifted (example: Diskhaler),is called a

A)unit dose DPI.
B)multiple unit dose DPI.
C)multiple-dose DPI.

Question 42

A device that measures the dose either from a powder reservoir or blister strips prepared by the manufacturer (examples: Twisthaler,Flexhaler,and Diskus)is called a

A)unit dose DPI.
B)multiple unit dose DPI.
C)multiple-dose DPI.

Question 43

The most frequently occurring particle size in the distribution is called

A)count mode.
B)count median diameter (CMD).
C)mass median diameter (MMD).
D)geometric standard deviation (GSD).

Question 44

The particle size above and below which 50% of the particles are found is termed

A)count mode.
B)count median diameter (CMD).
C)mass median diameter (MMD).
D)geometric standard deviation (GSD).

Question 45

These devices have individually wrapped capsules that contain a single dose of medication and deliver powder medication from a punctured capsule (examples: Aerolizer and HandiHaler).

A)Unit dose DPI
B)Multiple unit dose DPI
C)Multiple-dose DPI

Question 46

________________ is the particle size above and below which 50% of the mass of the particles are found.

A)Count mode
B)Count median diameter (CMD)
C)Mass median diameter (MMD)
D)Geometric standard deviation (GSD)